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FOROFFICE USE 7 3 0 f-- ------------------------- Z/ o r - ti A _._.. _- '�' APPLICATION FOR SANITATION PERMIT Permit No. _ � ---- -----_-- _-_- _ __ Q This Permit Expires 1 Year From Date Issued Date Issued ______ __ - --- (Complete in Duplicate) � _4 m& - l,Sv-v Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. `,t 4[54; _ jk/- - _- 'JOB ADDRESS AND LOCATION-- W1 ktE . "- Owner's Name----- -----�. .27_A-1.f_10-111x.---------------------------------------- ---------------------- --------------- ---- Phone__-------- a.. Address_............C?Y/ •'S,- r •��,��2 Contractors Name---------=--- -- - - y .. Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court (] Motel ❑ Other ❑ L')VP/est Number of living units: _d,__ Number of bedrooms _f___ Number of baths _x___ Lot size x7 - ---------------------------------------------- _ r Water Supply: Public system ❑ Community system ❑ Private ©- Depth to Water Table 464'ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Q` Hardpan ❑ Previous Application Made: (If yes,date--------------------) No 19 New Construction: Yes P- No ❑ FHA/VA: Yes ❑ No ['j- ^t1 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well__�O_�____Distance from foundation__./----------Material__ e—tky°zd� No. of compartments..-.--- .._.___-_ Size__�X -- A J - Liquid depth °--------- ----Capacity----- Disposal Field: - Distance from nearest well.-J' ...._Distance from foundation___!P_..__.._--:Distance to nearest lot line___,`�_r______----- Number of lines_____________ r C• ® ----------- ------Length of each line-_--_71'_________.____--.Width of french-----_Zt______---- Type of filter material---off�f;A%-------Depth of filter material----/__tT__�________-Total length-------- - -------------- f __--_ ?_-- Seepage Pit: Distance to nearest well---Zk�----------Distance from foundation __�9__�---___Distance to nearest lot line__-Jr-_'-__..._ 1�r� Number of pits.___----'Y-----------Lining material___ p 4.&_...Size: Diameter-__23__.`-.---.--__Depth-----Z_S ------------------ f`^-- Ce ool: Distance from nearest well------------------Distance from foundation---.--'--------------Lining material------------------------ ------------ 4- El❑ ¢e: i - ---------- -------------------Depth--------------- ------------------`-------------..Liquid Capacity----------------------------gals. Privy: Distance from-nearest weft_____________________ Distance from nearest.building_____.__._______________----------.------ ❑ Distance to nearest lob line--------------------- -- I Remodeiing and/or repairing (describe)________________________________---._ ----------- --------------------------------------------------------------------------------------------—------------------------------------------------------•----------------- ------ ' -----------------------------------------------------------------------W-W------------------------------------------------------------------------------------------------------------------------------------- I -----------------------------------------------I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, an rules and regulations of the San Joa in Local Health District. {Signed)----------. ------- ------------- - - -- - -- -•-------------------(Owner and/or Contractor $y::-------- -------- ------------------------------------------------(Title)------ --------------------- ----------- -- . -- ------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY Ly APPLICATION ACCEPTED BY_ =t:' ----------- ------------- DATE------�/ , REVIEWED BY--------------- -------------- ---- ----- ----- DATE--------- BUILDING PERMIT ISSUED..--.-.-,.----------- ----------- ------------ DATE------------------------------- --- ----------- � Alterations and/or recommendations:- �. _ � � t __-__ - - ___._._____.-- _ .____ _- �r _C -- /C_ --- ----- -c�----- � ` �� `�� sem.>r �_ L 7 7/ ---l ---- �G �_� --�Cx-r � .ti t-•+-� _ � �-J�.r.l, c�"'�^t-1"�'l- , FINAL INSPECTION BY... ----'(_ � -----------------------r -. Date / - ------------ --------- lf+-r-L L:-sem /J�.e`•-`, � ".C� 'r---C_v-TS--�,.o--� � _________7"""`__.. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:*lton Ave. .340 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 4 REVMFD 0-59 3M 3-'63 F.P=. ' i v